News & Updates

Modern Healthcare source | Comments by Matt Zavadsky

An option that may help keep rural hospitals open, at least for emergency care, and prevent rural EMS agencies from transporting some patients great distances.

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New law offers rural hospitals new payment model—if they scrap inpatient beds

Jessie Hellman

June 23, 2021

Rural hospitals facing closure will soon have another option: a payment model that allows them to convert to standalone emergency departments while ending inpatient services.

 

Starting in 2023, CMS will offer a new "Rural Emergency Hospital" designation to facilities that agree to wind down inpatient care and build up outpatient services.

 

The program, authorized by a spending bill President Donald Trump signed last December, aims to help facilities become more financially stable by scaling back their operations while maintaining some critical services for patients.

 

This option won't be enough to halt the ongoing spate of rural hospital closures, which have reached 180 since 2005, including 20 last year alone, according to data from the University of North Carolina. But it could enable rural hospitals that see very few inpatients to avoid shuttering entirely.

 

"This new model is really targeted at communities which, for whatever reason, are not able to sustain an inpatient hospital. This is seen as an alternative to having a closure," said George Pink, a professor at the University of North Carolina at Chapel Hill's Department of Health Policy and Management.

 

The Rural Emergency Hospital model is the first new hospital designation Congress has created in decades. In 1997, lawmakers established the "Critical Access Hospital" model that boosted Medicare reimbursements in an attempt to stop rural hospital closures, but it has had limited success. Most of the nation's rural hospitals are CAHs. And these facilities must maintain at least 25 inpatient beds in order to retain that designation and the special payments that come with it. The new policy is intended for small rural hospitals with very low inpatient volumes, as few as one or day a day.

 

Bottom of Form

For some rural hospitals, the high fixed costs of maintaining inpatient services for shrinking local populations and declining patient volumes has become an albatross around their necks, with a growing number eventually closing under financial pressure.

 

The ability to dump those inpatient services while still getting higher reimbursements from CMS through the Rural Emergency Hospital designation could be a lifeline for some, said John Hawkins, senior vice president of government relations at the Austin-based Texas Hospital Association.

 

"I think there's a considerable number of hospitals that will take advantage of this," he said. Twenty-four rural hospitals have closed in Texas since 2005, the most of any state during that time period, the UNC database shows.

 

"They basically have kept their inpatient status so they can access the 101% cost-based reimbursement," Hawkins said.

"We ought to let them redesignate themselves in a way that meets the needs of the community but still give them enhanced federal funding."

 

Under the new policy, current Critical Access Hospitals and rural Prospective Payment System hospitals with fewer than 50 beds can convert to the new Rural Emergency Hospital (REH) status.

 

Using this designation, they can furnish outpatient services, including around-the-clock emergency care, observation, nursing facility services and ambulances—but not inpatient services. Because they're getting rid of inpatient care, REHs must have transfer agreements with regional Level 1 or Level 2 trauma centers.

 

In exchange, hospitals adopting the REH model will receive a Medicare outpatient rate that is 5% higher than what full-service hospitals receive, and will get monthly facility payments, although the size of those payments remains undetermined. The program begins Jan. 1, 2023.

 

The Medicare Payment Advisory Committee (MedPAC) called for a voluntary payment model geared toward standalone emergency departments in rural areas that can't support inpatient services in a 2018 report, a recommendation reflected in the new statute.

 

MedPAC raised concerns about the impact on access to emergency care in rural communities when hospitals close their doors. Helping a facility maintain outpatient services while eliminating costly inpatient care that can be provided elsewhere—albeit at a location further away—can help these rural facilities remain in business, the panel concluded.

 

"They want to continue to be that access point of care in their communities, but staying open as an acute care facility may not be the most feasible option—both financially, and it's just not what the community ultimately needs," said Carrie Cochran-McClain, the chief policy officer at the Overland Park, Kansas-based National Rural Health Association (NRHA).

 

"It's scary to give up inpatient services but that might be a better alternative than losing a hospital altogether," she said.

 

The NRHA estimates between 50 and 100 hospitals will be eligible to become REHs. There are more than 1,800 rural hospitals in the U.S., and one-fourth of them are vulnerable to closure based on financial performance, according to the Chartis Center for Rural Health. Even more could become at risk of closure in the post-pandemic landscape, according to the center.

 

A MedPAC report released earlier this month analyzed 40 rural hospitals that closed between 2015 and 2019: In all cases, they experienced large declines in all-payer inpatient admissions in the years before closure, largely due to patients going elsewhere for care. From 2005 to 2014, these hospitals averaged a 54% drop in inpatient admissions.

 

"I think the model holds promise to be an alternative, innovative new way of meeting healthcare needs in rural communities where inpatient hospitals might close," said UNC's Pink. "The uptake will depend on the outcome of the rulemaking process CMS is going through. There has to be a financial case for hospitals to take it up."

 

Still, the program is voluntary. Hospitals should go through multiple levels of analysis to determine whether changing designations is advisable, said Martie Ross, office managing principal for PYA, a healthcare consulting and accounting firm headquartered in Kansas. The fact that CMS has yet to issue regulations is a significant obstacle to hospitals' decision making in the meantime.

 

Facilities will have to consider factors such as the need for inpatient services in their communities, their capacity for EMS services and their relationships with other regional hospitals.

 

While some rural hospitals could save money and improve their margins by closing inpatient services, it's not clear if the new model will provide enough revenue to cover operating costs. That could prove a tough sell.

 

"Where I think this makes sense, or where I think it's likely the math will work, are smaller hospitals that are part of health systems," Ross said.

 

For many rural hospitals, the decision undoubtedly will come down to money over other considerations. PYA's state-based analysis of the REH payment model found that it would cover between 80% to 87% of rural hospitals' costs.

 

That analysis doesn't take into account the monthly facility payment REHs would receive under the program, but CMS hasn't revealed what that will be. Based on the formula laid out in the law, each REH could get about $1 million per year in facility payments, Ross estimated. Hospital industry groups maintain that the law allows CMS to boost these payments so REH's come out ahead financially.

 

Other obstacles to transitioning to an REH include state licensing requirements and community objections to losing local access to inpatient services.

 

"The law is basically saying: We want to help you by giving you money, but the only way we'll give you money is if you give up a service that might be critically important to your community," said Harold Miller, president and CEO for the Center for Healthcare Quality and Payment Reform in Pittsburgh. "If a hospital closes more services, it's going to be easier for it to close altogether and transfer all the outpatient services to a larger system."

 

Whether the REH designation would benefit specific hospitals might be "random," Miller said. The formula laid out in law for the facility payment—which could be key to the program succeeding for rural hospitals—doesn't take into account each hospital's specific characteristics, such as their patient population and finances. Instead, each participating facility would receive the same amount of money.

 

While an REH designation might be beneficial to some hospitals, particularly those that are already looking to scrap inpatient services, "there's no solution for the others in this situation," Miller said.

 

 

 

Modern Healthcare | Comments courtesy of Matt Zavadsky

Yes, it’s 1% of their workforce, but a bold move that seems to be backed by the recent decision on this issue by the EEOC.  99% of the staff have been vaccinated.

And, the EUA may be ending soon, which no longer provides the ‘experimental’ argument.

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Houston Methodist suspends 178 workers for two weeks for failing to get vaccinated

June 08, 2021

https://www.modernhealthcare.com/hospitals/houston-methodist-suspends-178-workers-two-weeks-failing-get-vaccinated

Houston Methodist suspended 178 workers for failing to get fully vaccinated by the deadline set by the health system, the CEO said Tuesday.

In a letter to all employees and physicians, CEO Marc Boom said the 178 workers will be suspended without pay for two weeks, giving them another chance to either get the second dose of the Pfizer or Moderna vaccine or a single-shot Johnson & Johnson vaccine. In April, Boom told employees that COVID-19 vaccines would be mandatory, and those who did not comply would face termination.

"The small percentage of employees who did not comply with the policy are now suspended without pay for the next 14 days," Boom said. "I wish the number could be zero, but unfortunately, a small number of individuals have decided not to put their patients first."

As of Tuesday, 24,947 Houston Methodist employees — nearly 100% — had been fully vaccinated, Boom said. Of the 178 suspended, 27 had received one dose of the vaccine. Another 285 received a medical or religious exemption, and 332 were granted deferrals for pregnancy and other reasons, Boom told employees. Some of the affected employees protested the system's mandate Monday, the deadline set for workers to have become fully vaccinated, the New York Times reported.

"While we celebrate this remarkable accomplishment, I know that today may be difficult for some who are sad about losing a colleague who's decided to not get vaccinated. We only wish them well and thank them for their past service to our community, and we must respect the decision they made," Boom said. "Since I announced this mandate in April, Houston Methodist has been challenged by the media, some outspoken employees and even sued. As the first hospital system to mandate COVID-19 vaccines we were prepared for this. The criticism is sometimes the price we pay for leading medicine."

The health system was sued in late May by 117 employees over the vaccine mandate. In the complaint, employees alleged that "Methodist Hospital is forcing its employees to be human 'guinea pigs' as a condition for continued employment" and is violating the Nuremberg Code, which prohibits human experimentation without consent. At that time, Boom said 99% of the hospital's 26,000 employees already had been vaccinated.

The complaint which was filed in the District Court of Montgomery County in Texas, alleged that employers can't mandate vaccines that haven't yet received FDA approval, calling the vaccines "experimental." The COVID-19 vaccines only have received emergency use authorization.

On May 28, the federal Equal Employment Opportunity Commission updated its COVID-19 guidance to clarify that an employer can require employees to be vaccinated for COVID-19 to enter a physical workplace, as long as accommodations are made for those who can't get vaccinated for medical or religious reasons.

Houston Methodist is one of a small number of healthcare providers that are mandating the COVID-19 vaccine for workers. In mid-May, the University of Pennsylvania Health System announced that all employees and clinical staff would be required to be vaccinated against COVID-19 by Sept. 1. Starting July 1, Penn Medicine also will require all new hires to be vaccinated before starting work.

New study just released today on the use of ketamine in the out-of-hospital setting.

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Out-of-Hospital Ketamine: Indications for Use, Patient Outcomes, and Associated Mortality

Antonio R. Fernandez, PhD, NRP*; Scott S. Bourn, PhD, RN; Remle P. Crowe, PhD, NREMT; E. Stein Bronsky, MD; Kenneth A. Scheppke, MD; Peter Antevy, MD; J. Brent Myers, MD, MPH

 

June 7, 2021

 

https://www.sciencedirect.com/science/article/pii/S0196064421001529?dgcid=coauthor

 

Study objective:

To describe out-of-hospital ketamine use, patient outcomes, and the potential contribution of ketamine to patient death.

 

Methods:

We retrospectively evaluated consecutive occurrences of out-of-hospital ketamine administration from January 1, 2019to December 31, 2019 reported to the national ESO Data Collaborative (Austin, TX), a consortium of 1,322 emergency medical service agencies distributed throughout the United States. We descriptively assessed indications for ketamine administration, dosing, route, transport disposition, hypoxia, hypercapnia, and mortality. We reviewed cases involving patient death to determine whether ketamine could be excluded as a potential contributing factor.

 

Results:

Indications for out-of-hospital ketamine administrations in our 11,291 patients were trauma/pain (49%; n=5,575), altered mental status/behavioral indications (34%; n=3,795), cardiovascular/pulmonary indications (13%; n=1,454), seizure (2%; n=248), and other (2%; n¼219). The highest median dose was for altered mental status/behavioral indications at 3.7 mg/kg (interquartile range, 2.2 to 4.4 mg/kg). Over 99% of patients (n=11,274) were transported to a hospital. Following ketamine administration, hypoxia and hypercapnia were documented in 8.4% (n=897) and 17.2% (n=1,311) of patients, respectively. Eight on-scene and 120 in-hospital deaths were reviewed. Ketamine could not be excluded as a contributing factor in 2 on-scene deaths, representing 0.02% (95% confidence interval 0.00% to 0.07%) of those who received out-of-hospital ketamine. Among those with in-hospital data, ketamine could not be excluded as a contributing factor in 6 deaths (0.3%; 95% confidence interval 0.1% to 0.7%).

 

Conclusion:

In this large sample, out-of-hospital ketamine was administered for a variety of indications. Patient mortality was rare. Ketamine could not be ruled out as a contributing factor in 8 deaths, representing 0.07% of those who received ketamine.

HealthAffairs Source Article | Comments Courtesy of Matt Zavadsky

EMS providers and other healthcare experts continue to encourage people to not delay seeking medical care for potentially serious medical complaints.

 

Excerpts from the study and full study link:

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Worse Cardiac Arrest Outcomes During The COVID-19 Pandemic In Boston Can Be Attributed To Patient Reluctance To Seek Care

Christopher Sun, Sophia Dyer, James Salvia, Laura Segal, and Retsef Levi

PUBLISHED: MAY 26, 2021

 

Conclusion

The indirect effects of COVID-19 pose substantial immediate and long-term public health challenges. During the pandemic, patient avoidance and reluctance in seeking emergency care via EMS significantly increased compared with historical baselines. The avoidance of care and resulting possible treatment postponement likely played a critical role in the excess out-of-hospital cardiac arrests observed during the same time. The sustained changes in patients’ care-seeking behaviors and excess OHCA deaths after the initial COVID-19 wave may foreshadow the harmful long-term indirect effects of COVID-19 on health care systems. Ensuring that patients seek timely care during and after the pandemic is essential, to reduce potentially avoidable excess cardiovascular disease deaths.

 

Abstract

Delays in seeking emergency care stemming from patient reluctance may explain the rise in cases of out-of-hospital cardiac arrest and associated poor health outcomes during the COVID-19 pandemic.

 

In this study we used emergency medical services (EMS) call data from the Boston, Massachusetts, area to describe the association between patients’ reluctance to call EMS for cardiac-related care and both excess out-of-hospital cardiac arrest incidence and related outcomes during the pandemic. During the initial COVID-19 wave, cardiac-related EMS calls decreased (−27.2 percent), calls with hospital transportation refusal increased (+32.5 percent), and out-of-hospital cardiac arrest incidence increased (+35.5 percent) compared with historical baselines. After the initial wave, although cardiac-related calls remained lower (−17.2 percent), out-of-hospital cardiac arrest incidence remained elevated (+24.8 percent) despite fewer COVID-19 infections and relaxed public health advisories. Throughout Boston’s fourteen neighborhoods, out-of-hospital cardiac arrest incidence was significantly associated with decreased cardiac-related calls, but not with COVID-19 infection rates. These findings suggest that patients were reluctant to obtain emergency care. Efforts are needed to ensure that patients seek timely care both during and after the pandemic to reduce potentially avoidable excess cardiovascular disease deaths.

 

Change In Characteristics And Outcomes:

Beyond increased OHCA incidence, worse OHCA outcomes may also demonstrate the repercussions of patient reluctance and COVID-19. While assessing these relationships, OHCA patient and response characteristics with confounding effects on OHCA outcomes must also be examined. Accordingly, both the changes in OHCA outcomes and cofounding patient and response characteristics were assessed during and after the initial COVID-19 wave, relative to the historical baselines.

 

Discussion

This study supports the hypothesis that treatment delays resulting from increased patient reluctance to obtain urgent care contributed to the increased absolute and relative volume of non–nursing home out-of-hospital cardiac arrest incidence and death during the COVID-19 pandemic. Specifically, the substantial decrease in cardiac calls and increase in hospital transportation refusals during the pandemic supports the hypothesis of increased patient reluctance to seek EMS and in-hospital care.

 

As positive cardiac outcomes are dependent on timely treatment after symptom onset,^12–14 these prolonged delays could explain the significantly increased rates of OHCA incidence and poor outcomes. In fact, these treatment delays may play a larger role in increasing OHCA incidence compared with the direct impact of COVID-19 infection.^5,26 

 

The Poisson regression analysis indicated that OHCA incidence was strongly associated with increased reluctance to call EMS and the initial COVID-19 wave period, during which barriers of obtaining care were abundant (for example, infection fears, financial instability, and stay-at-home advisories), but not with neighborhood-level COVID-19 infection rates.

 

Importantly, patients’ reluctance to seek emergency care and OHCA incidence remained elevated despite the low COVID-19 infection rates and relaxed public health advisories after the initial COVID-19 wave. This not only suggests the greater impact of patient reluctance on excess OHCA incidence compared with COVID-19 infections but also raises concerns regarding the potential long-term indirect effects of COVID-19. Lasting changes in patients’ care-seeking behaviors that worsen the underuse of EMS could result in increased mortality rates for acute conditions.^9–12

 

The increased EMS avoidance and hospital transportation refusals during the pandemic were likely driven by patients’ reluctance to obtain care as opposed to unneeded medical attention. The decreased cardiac call volume and higher proportion of OHCAs among all cardiac calls suggests that at least some of the patients were only calling EMS during extreme emergencies. There is also evidence that some patients acted against explicit medical advice and refused transportation to a hospital after calling EMS. At least some of these patients experienced OHCA less than seven days after their initial EMS call, indicating that these refusals occurred despite worsening conditions. Moreover, historically, transportation refusals represent a reluctance to obtain necessary care, as approximately one in five patients refusing transportation received subsequent care at an emergency department within forty-eight hours after their refusal.^27,28 Increases in refusal rates during the pandemic may similarly indicate higher patient reluctance to obtain care.

Modern Health Source Articles |Comments Courtesy of Matt Zavadsky

There are 2 important articles in Modern Healthcare this morning.  Combining them for you to cut out at least one more email for all of you.. 

 

The first details an effort by Congress to make some telehealth waivers permanent.  This could be of big interest to EMS agencies and their partners, especially in geography that makes video telemedicine difficult. 

 

The bigger impact of the proposal may be the removal of the restriction that the patient be IN a healthcare facility.  This could potentially have 2 impacts on EMS.  1) It could enhance our ability to do things like telehealth enabled patient navigation from a 911 scene, especially in areas with challenging cell coverage; and 2) as CMS further evaluates the expansion of ‘Hospital at Home’ models, EMS could be part of the assessment team for routine or episodic needs of the patient ‘hospitalized’ at home.  One of the CMS PHE waivers specifically allows mobile healthcare paramedics to provide assessments and care to patients that we in this model of care/reimbursement.

 

The 2^nd article is the data/outcome/utilization of the Medicare preauthorization program for repetitive, non-emergency patients.  Interesting finding, and as result, the program is rollout out country-wide I the fall 2021.

 

Interesting times for sure!

 

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Congress wants permanent Medicare coverage of audio-only telehealth

JESSIE HELLMANN

May 24, 2021

https://www.modernhealthcare.com/clinical/congress-wants-permanent-medicare-coverage-audio-only-telehealth

 

Medicare would permanently cover audio-only telehealth visits under a new bill introduced Monday by two members of Congress.

 

The bill, introduced by Rep. Jason Smith (R-Mo.) and Josh Gottheimer (D-N.J.), would also remove a requirement that patients receive telehealth services at a health facility for it to be covered by Medicare.

 

CMS temporarily waived dozens of limitations on telehealth coverage during the COVID-19 pandemic, but the old restrictions will resume after public health emergency unless Congress acts.

 

Providers and members of Congress have argued the waivers should be made permanent, especially to benefit patients who live in rural areas where patients may not have internet access for video calls.

 

"This method of healthcare delivery should serve as a bridge to provide better care and remain a permanent option for patients who will not gain access to broadband and technology overnight," Smith said.

 

The bill is supported by the Medical Group Management Association (MGMA), Healthcare Leadership Council, and others.

 

Before COVID-19, Medicare's coverage of telehealth services was fairly limited. CMS waived dozens of restrictions, making it easier for patients to use telehealth during the pandemic when they were avoiding healthcare facilities.

 

Congress is now working to decide which waivers should be made permanent, but some lawmakers have concerns about potential fraud, waste and cost.

 

MedPAC has cautioned Congress to temporarily allow targeted telehealth expansion for a few more years to gather more data on costs and outcomes.

 

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CMS: Prior authorization slashed ambulance transportation by 70%

MICHAEL BRADY

May 24, 2021

https://www.modernhealthcare.com/finance/cms-prior-authorization-slashed-ambulance-transportation-70

 

Prior authorization dramatically lowered the use of regular, non-emergency ambulance transportation among Medicare beneficiaries without affecting quality or beneficiaries' access to care, according to a government report on Monday.

 

Those are the results of a CMS Center for Medicare and Medicaid Innovation experiment to test whether requiring ambulance service providers to get pre-approval for such services would reduce their use among Medicare beneficiaries with End-stage Renal Disease or pressure ulcers.

 

Researchers found that prior authorization reduced unnecessary use and spending by more than 70%, lowering total Medicare spending by 2.4%. The findings suggest that expanding prior authorization for regular non-emergency ambulance transportation could save Medicare even more money without affecting beneficiaries' health.

 

"That said, we believe these savings would be smaller than those estimated in this report. Given that CMS initially chose model states with particularly high baseline rates of RSNAT use, the findings here may not generalize to states that have more moderate rates of RSNAT use," the report said.

 

CMS announced that it plans to expand the program nationwide in September. But it won't add new states until the pandemic is under control.

 

According to CMMI, prior authorization reduced Medicare spending among the original states far more than the ones added by Congress. For each quarter, spending in New Jersey, Pennsylvania and South Carolina dropped by $481 per beneficiary compared to just $112 per beneficiary in the congressionally-mandated states.

 

The agency has been testing prior authorization for repetitive, scheduled, non-emergency ambulance transportation for its Medicare beneficiaries in several states since 2014 to address concerns about improper payments for those services.

 

PRIOR AUTHORIZATION AND RSNAT SERVICES

A study of the impact on prior authorization for repetitive scheduled non-emergent ambulance transport (RSNAT services) found a Medicare model reduced both usage and Medicare expenditures.

 

CNN Source Article | Comments courtesy of Matt Zavadsky

Sadly, this scenario is accentuated in rural communities.  But, it’s also a growing challenge in most all EMS agencies, rural, suburban and urban.

NAEMT, the American Ambulance Association, the International Association of Fire Chiefs, and the International Association of Fire Fighters are collaborating on a number of initiatives to try and help with the major economic challenges facing our nations EMS agencies. 

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Rural ambulance crews are running out of money and volunteers. In some places, the fallout could be nobody responding to a 911 call

By Lucy Kafanov, CNN

Sat May 22, 2021

Worland, Wyoming (CNN)  America's rural ambulance services, often sustained by volunteers, are fighting for their survival -- a crisis hastened by the impact of Covid-19.

More than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The pandemic has further stretched the resources of our nation's rural EMS."

 

In Wyoming, the problem is especially dire. It may have the smallest population in America, but when it comes to land, Wyoming is the ninth-largest.

 

In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here: While there is vast open space, the nearest major trauma hospital is more than 2.5 hours away.

 

On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.

 

But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival.

 

It's a fact Luke Sypherd knows all too well. For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve.

 

"We just saw that we didn't have the personnel to continue," Sypherd said. "It was an ongoing problem made worse by Covid with fewer people interested in volunteering with EMS during a pandemic and patients afraid of getting taken to a hospital."

 CONTINUE READING►

FOR IMMEDIATE RELEASE: May 13, 2021

Media Contact:

Jenny Abercrombie
jabercrombie@firstwatch.net
951.440.6848

FirstWatch and the Academy of International Mobile Healthcare Integration (AIMHI) Partner to Fund the Jack Stout Archive at The National EMS Museum

Online Collection will Showcase the Late EMS Visionary’s Legacy

Carlsbad, Calif.—FirstWatch, a technology and quality improvement company serving public safety and healthcare organizations, has partnered with the Academy of International Mobile Healthcare Integration to preserve the written legacy of the late EMS visionary Jack Stout. The partnership will fund an online archive hosted by The National EMS Museum, making more than 100 of Stout’s articles and essays available to the public. Many of them appeared in JEMS, the Journal of Emergency Medical Services, beginning with his pivotal series introducing the concepts of high-performance EMS in the May 1980 edition.

As EMS Week approaches with the theme of, “This is EMS: Caring for our Communities,”

Keith Griffiths, the founding editor of JEMS and now a partner with the RedFlash Group, noted that

Stout is known for creating efficiency in EMS systems. However, his philosophy was very much about doing what was best for the patient and their community, according to their priorities and policies.  Griffiths worked with Stout on dozens of his articles and columns. “He was a brilliant communicator and storyteller,” he said, “taking abstract concepts and making them come alive with clear, down-to-earth prose that still resonates today.”

Known as the “Father of High-Performance EMS and System Status Management,” Stout developed his concepts in the 1970s to improve EMS systems by making them more efficient and focused on patient care. An economist by trade, he found that applying the science, concepts, and economics used in manufacturing provided the framework for standing up high-quality EMS systems that could afford to provide effective and reliable prehospital care.

Stout’s son, FirstWatch Founder and President, Todd Stout, has granted The National EMS Museum the rights to provide access to all of his father’s articles in a format that’s fully searchable. “Teaming up with AIMHI was the natural and obvious choice to enable The National EMS Museum to ensure my father’s work, which is still so timely today, is available for future generations to learn from,” he said. “We appreciate that JEMS provided a good home for his ideas for more than a decade.”

The National EMS Museum will digitally transcribe and catalog the documents as part of itsdigital library and research archives—part of the virtual museum program created and maintained by volunteers. Many of the articles are already available in the museum’s online Jack Stout Archive. Additional material will be added in future months.

“We’re delighted to preserve and share these historical and transformative articles,” said Kristy Van Hoven, the museum’s director.

“AIMHI is proud to partner with FirstWatch to contribute to the creation of the Jack Stout rchive,” said Chip Decker, president of AIMHI and CEO of the Richmond Ambulance Authority. “His legacy lives on as many of our member organizations were formed around the high-performance principles and practices of Jack’s work—which is increasingly valuable in today’s economically-challenged EMS landscape.”

The principles established by Stout led to the creation (by him, Jay Fitch, and others) of nationally recognized and award-winning high-performance EMS systems including the Three Rivers Ambulance Authority (TRAA) in Fort Wayne, Indiana; the Richmond Ambulance Authority (RAA) in Richmond, Virginia; Metropolitan EMS (MEMS) in Little Rock, Arkansas; the Regional EMS Authority (REMSA) in Reno, Nevada; the EMS Authority (EMSA) in Tulsa and Oklahoma City, Oklahoma; the Sunstar system in Pinellas County, Florida; and MEDIC in Charlotte, North Carolina. 

On June 24, FirstWatch will host a special edition of Conversations That Matter—a series of thought-provoking discussions in EMS—to answer the question, “Who Was Jack and Why Do His Ideas Still Resonate?” Facilitators Mike Taigman and Rob Lawrence will be joined by Kristy Van Hoven, Todd Stout, Keith Griffiths, and Jon Washko, a “Stoutian” disciple and highly respected consultant and EMS system expert, to explore why Stout’s ideas remain critically relevant for today’s EMS leader and key to the design of EMS systems of the future. Register for the session now here.  

###

About FirstWatch

FirstWatch helps public safety and healthcare professionals serve their communities through the use of technology and the science of quality improvement. Drawing on deep experience in emergency services, the FirstWatch team develops software and personalized solutions to help organizations continuously improve at what they do. Founded in 1998, and based in Carlsbad, Calif., FirstWatch has partnered with more than 500 communities across North America to improve outcomes, efficiency, safety, and operations. Learn more at: https://firstwatch.net.

About the Academy of International Mobile Healthcare Integration (AIMHI)

The Academy of International Mobile Healthcare Integration (AIMHI) represents high performance emergency medical and mobile healthcare providers in the U.S. and abroad. AIMHI, formerly known as the Coalition of Advanced Emergency Medical Services (CAEMS), changed its name in March 2015 to better reflect its members’ dedication to promoting high performance ambulance and mobile integrated healthcare systems working diligently to performance and technological advancements. Member organizations are high performance systems that employ business practices from both the public and private sectors. By combining industry innovation with close government oversight, AIMHI affiliates are able to offer unsurpassed service excellence and cost efficiency. Learn more at: http://aimhi.mobi/.

About The National EMS Museum

The National EMS Museum is dedicated to preserving and commemorating the history of EMS in the U.S. By collecting historic equipment, books, articles and tools of the trade, the museum showcases how EMS has developed over the last 150 years. Through the study of the past, the museum strives to inspire EMS practitioners and leaders of today to develop new tools and procedures to provide better and more effective emergency care to patients and communities. Learn more at: https://emsmuseum.org/.

From Matt Zavadsky

For those who may not have heard yet, today, CMS released the waiver on Medicare treatment-in-place for ground ambulance services for the Public Health Emergency.

Several EMS Association leaders were invited to meet with CMS today as they announced the waiver.

This provides reimbursement to ambulance services for 911 responses to patients who are not brought to local hospitals due to a community-wide protocol designed to preserve health system capacity.

Typically, ambulance agencies are only reimbursed if they transport a patient to an emergency room.

Highlights of the waiver include:

• Medicare reimbursement for patients treated in place due to a community-wide EMS protocol.
• For dates of service starting March 1, 2020 and lasting through the end of calendar year in which the PHE ends.
• Can be billed through May 5, 2022.
• ALS and BLS base reimbursement eligible, depending on level of service provided.
• Does not require the use of telemedicine.

This waiver recognizes the value of the critical role EMS professionals play in the healthcare system.

THANK YOU to the members and leadership of the National Association of Emergency Medical Technicians, American Ambulance Association, International Association of Fire Chiefs and International Association of Fire Fighters who collaborated to get this important legislation passed.

Thanks also to the Members of Congress for voting for this waiver, and the staff at CMS who have been very supportive of this initiative.

https://www.cms.gov/files/document/covid-waiver-medicare-ground-ambulance-services-treatment-place.pdf

ABC Source | Comments Courtesy of Matt Zavadsky

Very well done by ABC News!

NYT Source Article | Comments Courtesy of Matt Zavadsky

A GREAT, but troubling article in the NYT about the plight of rural EMS agencies.  Excellent reporting and insight!

This is why organizations like NAEMT, the American Ambulance Association, the International Association of Fire Chiefs and the International Association of Fire Fighters, are working together on federal initiatives to help fund rural EMS systems, such as the SIREN Act and reimbursement for Treatment in Place (TIP).

If you are not part of these efforts, consider lending your support!

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Rural Ambulance Crews Have Run Out of Money and Volunteers

Strained by pandemic-era budget cuts, stress and a lack of revenue, at least 10 ambulance companies in Wyoming are in danger of shuttering — some imminently.

By Ali Watkins

April 29, 2021

WORLAND, Wyo. — For three years, Luke Sypherd has run the small volunteer ambulance crew that services Washakie County, Wyo., caring for the county’s 7,800 residents and, when necessary, transporting them 162 miles north to the nearest major trauma center, in Billings, Mont.

In May, though, the volunteer Washakie County Ambulance Service will be no more.

“It’s just steadily going downhill,” Mr. Sypherd said. The work is hard, demanding and almost entirely volunteer-based, and the meager revenue from bringing patients in small cities like Worland to medical centers was steeply eroded during much of 2020 when all but the sickest coronavirus patients avoided hospitals.

Washakie County’s conundrum is reflective of a troubling trend in Wyoming and states like it: The ambulance crews that service much of rural America have run out of money and volunteers, a crisis exacerbated by the demands of the pandemic and a neglected, patchwork 911 system. The problem transcends geography: In rural, upstate New York, crews are struggling to pay bills. In Wisconsin, older volunteers are retiring, and no one is taking their place.

The situation is particularly acute in Wyoming, where nearly half of the population lives in territory so empty it is still considered the frontier. At least 10 localities in the state are in danger of losing ambulance service, some imminently, according to an analysis reviewed by The New York Times.

Many of the disappearing ambulances are staffed by volunteers, and some are for-profit ambulance providers that say they are losing money. Still others are local contractors hired by municipalities that, strained by the budget crisis of the pandemic, can no longer afford to pay them. Thousands of Wyoming residents could soon be in a position where there is no one nearby to answer a call for help.

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